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Epilepsy: HELP
Articles by Heather Angus-Leppan
Based on 14 articles published since 2010
(Why 14 articles?)

Between 2010 and 2020, H. Angus-Leppan wrote the following 14 articles about Epilepsy.
+ Citations + Abstracts
1 Review Valproate, sexual health, and men: A narrative review. 2020

Watkins, Lance Vincent / Angus-Leppan, Heather. ·Swansea Bay University Health Board, Mental Health and Learning Disability Delivery Unit, LLwyneryr Unit, Swansea, United Kingdom. Electronic address: Lance.watkins@wales.nhs.uk. · Epilepsy Initiative Group, Royal Free London, United Kingdom; University College London, United Kingdom. ·Epilepsy Behav · Pubmed #31892466.

ABSTRACT: OBJECTIVE: This article explores current evidence about the effects of valproate (VPA) medicines on sexual health in men, how to monitor symptoms, communicate with patients, and improve clinical outcomes. There has been a lot of focus on VPA use in women of childbearing age following recent changes to prescribing regulations owing to the well-established and significant teratogenic risk. Concerns have been raised by patients and clinicians as to the risk of adverse sexual effects of VPA use in men. RESULTS: The evidence base for the effect of VPA on sexual function compared with other antiepileptic drugs (AEDs) in men is limited with no randomized controlled trials. Sexual function in men with epilepsy is complex, and there is no direct relationship between objective measures of sexual function and sexual satisfaction. Epilepsy, comorbidities, psychosocial factors, and most AEDs including VPA may cause sexual dysfunction in men, including reduced sexual desire, erectile dysfunction, and fertility problems. Sexual and reproductive function should be discussed with men prior to treatment with AEDs including VPA. CONCLUSION: Early and proactive discussion of sexual and reproductive functioning mitigates, rather than increases, the risk of sexual problems and potentially improves adherence. Sexual dysfunction in men with cognitive impairment [such as intellectual disability (ID) and dementia] may present with behavioral disturbance. Identification of sexual adverse effects of medication could significantly change treatment plans which is of particular importance for individuals with treatment resistance. We provide an information fact sheet for men to help guide prescribing discussions.

2 Review First seizures in adults. 2014

Angus-Leppan, Heather. ·Clinical Neurosciences, Royal Free London NHS Foundation Trust and Barnet Chase Farm Hospitals NHS Trust, London, UK. ·BMJ · Pubmed #24736280.

ABSTRACT: -- No abstract --

3 Review Migraine: mimics, borderlands and chameleons. 2013

Angus-Leppan, Heather. ·Department of Neurology, Barnet and Royal Free Hospitals, London, UK. heather.angus-leppan@nhs.net ·Pract Neurol · Pubmed #23906594.

ABSTRACT: Diagnostically, headache is the easy part of migraine. It is the surrounds of migraine--the aura, prodrome and postdrome--that can be most challenging, and confused with other pathologies. This article examines the definition and variants of migraine; alternative diagnoses for which migraine may be mistaken (mimics); conditions that lie between migraine and other diagnoses (borderlands) and the possible presentations of migraine posing as other conditions (chameleons). The focus is on adults, with only passing reference to children. Migraine is more often a chameleon than a mimic; and it is the careful history that usually makes the distinction. Given migraine's prevalence of 10-15%, relatively uncommon features of migraine occur quite often, in comparison with frequent manifestations of less common diseases. Thus, even rare or under-recognised presentations of migraine come into the differential diagnosis of many presentations.

4 Article Orgasmic migraine aura: Report of two cases. 2019

Angus-Leppan, Heather / Caulfield, Alice. ·1 Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, UK. · 2 University College London, London, UK. · 3 Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK. · 4 Royal Free London NHS Foundation Trust, London, UK. ·Cephalalgia · Pubmed #29682978.

ABSTRACT: BACKGROUND: Paroxysmal neurological symptoms occurring with sex cause considerable anxiety and sometimes have a serious cause. Thunderclap headache is the most well-known and requires urgent investigation at first presentation for subarachnoid haemorrhage and other significant pathologies. After exclusion of underlying causes, many prove to be primary headache associated with sexual activity. Orgasmic migraine aura without headache is not currently recognised as a clinical entity. CASE REPORTS: We report two patients with acephalgic orgasmic neurological symptoms fulfilling the criteria for migraine aura. CONCLUSIONS: The incidence of acephalgic orgasmic migraine aura is unknown. It should be considered as part of the differential of paroxysmal sex-related neurological symptoms, and clinically differentiated from fixed deficits, reversible cerebral vasoconstriction syndrome and post-orgasmic illness syndrome.

5 Article Focal epilepsy as a late complication of congenital dacryocystocele. 2018

Silva-Rosas, C / Quijada, A / Angus-Leppan, H. ·Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Chile. Electronic address: csilros@uchile.cl. · Department of Neurology & Neurosurgery, Clinical Hospital of University of Chile, Chile. · Clinical Neurosciences, Royal Free London NHS Foundation Trust, United Kingdom; Institute of Neurology, University College London, United Kingdom; Centre for Research in Public Health and Community Care, University of Hertfordshire, United Kingdom. ·Seizure · Pubmed #30005300.

ABSTRACT: -- No abstract --

6 Article Weighing the risks of valproate in women who could become pregnant. 2018

Angus-Leppan, Heather / Liu, Rebecca S N. ·Epilepsy Initiative Group, Royal Free London, London, UK heather.angus-leppan@nhs.net. · University College London. · Centre for Research in Public Health and Community Care, University of Hertfordshire. · Epilepsy Initiative Group, Royal Free London, London, UK. ·BMJ · Pubmed #29669717.

ABSTRACT: -- No abstract --

7 Article The provision of care to adults with an intellectual disability in the UK. A Special report from the intellectual disability UK chapter ILAE. 2018

Kerr, M P / Watkins, L V / Angus-Leppan, H / Corp, A / Goodwin, M / Hanson, C / Roy, A / Shankar, R / Anonymous8120936. ·Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, United Kingdom. · Psychiatry of Intellectual Disability, Abertawe Bro Morgannwg University Health Board, United Kingdom. Electronic address: lancevwatkins@doctors.org.uk. · Institute of Neurology, University College London, United Kingdom. · HS Greater Glasgow and Clyde, United Kingdom. · Northampton General Hospital NHS Trust, United Kingdom. · Abertawe Bro Morgannwg University Health Board, United Kingdom. · Royal College of Psychiatrists, Faculty of Psychiatry of Intellectual Disability, United Kingdom. · Cornwall Partnership NHS Foundation Trust, Exeter Medical School, United Kingdom. ·Seizure · Pubmed #29428900.

ABSTRACT: PURPOSE: This article reflects the report by the British Branch of the International League Against Epilepsy (ILAE) Working Group on services for adults with epilepsy and intellectual disability (ID). Its terms of reference was to explore the current status of aspects of the care of people with an ID and epilepsy. METHODS: Survey content was developed from key themes identified by consensus of the working group. An electronic survey was distributed via email. The sample population was the membership of the ILAE UK, Royal College of Psychiatrists (RCPsych) Faculty of ID, Epilepsy Nurses Association (ESNA), and the Association of British Neurologists (ABN). Following a six week response period the data was then collated, anonymised and distributed to the working group in order that opinion statements could be gathered. RESULTS: The time taken for individuals with both new-onset and established epilepsy to undergo routine investigation was commonly at least 1-3 months, far beyond recommendations made by NICE (CG20). A small minority of clinicians would not consider non-pharmacological interventions including epilepsy surgery, vagus nerve stimulation, and ketogenic diet for this population. Almost universally responders are actively involved in the assessment and management of key risk areas including risk of drowning, hospitalization, medication side effects, and sudden unexpected death in epilepsy (SUDEP). CONCLUSION: This investigation identifies key themes and recommendations relating to care delivery and meeting the complex needs of people with ID and epilepsy. Adults with ID and epilepsy appear to exist in a unique, but inadequate, segment of epilepsy care delivery.

8 Article Development of the Epilepsy Risk Awareness scale (ERA scale) for people with epilepsy. 2017

Braun, Andreas / Kendall, Sally / Cole, Christine / Smeeton, Nigel / Angus-Leppan, Heather. ·Centre for Research in Primary and Community Care, University of Hertfordshire, UK. · CHSS, University of Kent, Canterbury, UK. · Central London Community Healthcare Trust, UK. · Epilepsy Initiative Group, Royal Free London NHS Foundation Trust and University College London, UK. Electronic address: heather.angus-leppan@nhs.net. ·Seizure · Pubmed #28214711.

ABSTRACT: PURPOSE: Quality of life in people with epilepsy depends on balancing protection from risks and avoiding unnecessary restrictions. The Epilepsy Risk Awareness Checklist (ERAC) was developed to summarise an individual's safety, health care and quality of life and to facilitate communication between professionals. Although effective, the existing Checklist required quantification and shortening to increase its utility, particularly as a longitudinal tool for measuring and communicating changes over time. METHODS: 5 clinical experts, 3 people with epilepsy and 5 carers assessed the importance of each item on the ERAC questionnaire in a two-round Delphi survey. The refined Epilepsy Risk Awareness scale (ERA scale) was piloted in 30 patients to obtain an overall and sub-scale score for personal safety, health care, and quality of life domains, and was compared with the validated Seizure Severity Scale and Epilepsy Self-Management Scale. RESULTS: ERAC was shortened from 69 to 48 items to take 15-20min for completion. Pilot results showed good internal consistency for the overall ERA scale, for the Personal Safety and Health Care subscales, but less for the Quality of Life subscale. There was strong association between ERA scale and the Epilepsy Self-Management Scale, but little relationship with Seizure Severity Scale scores, which focus on individual seizures. User ratings were high. CONCLUSIONS: The ERA scale has been shortened and quantified to provide an objective measure of the risks and safety profile in people with epilepsy. The scale will be further tested for intra-rater variability and utility.

9 Article Discussing sudden unexpected death in epilepsy: Are we empowering our patients? A questionnaire survey. 2016

Keddie, S / Angus-Leppan, H / Parker, T / Toescu, S / Nash, A / Adewunmi, O / Liu, Rsn. ·Department of Neurology, National Hospital of Neurology and Neurosurgery, London WC1N 3BG, UK. · Department of Neurology, Royal Free Hospital, London NW3 2QG, UK; Neurosciences, University College London, London, UK. · Department of Neurology, Queen Square Hospital, London WC1N 3BG, UK. · Department of Neurology, Royal Free Hospital, London NW3 2QG, UK. ·JRSM Open · Pubmed #27688898.

ABSTRACT: OBJECTIVE: To examine patient knowledge about sudden unexpected death in epilepsy (SUDEP) compared to other risks in epilepsy. To explore patients' experiences surrounding SUDEP disclosure and opinions on how information should be delivered. DESIGN: A cross-sectional questionnaire. SETTING: Royal Free Hospital, London outpatient epilepsy clinics. PARTICIPANTS: New and follow-up patients attending epilepsy clinics at a London teaching hospital over six months. Patients identified as being at risk of suffering negative emotional or psychological consequences of SUDEP discussions were excluded. MAIN OUTCOME MEASURES: Patient knowledge about epilepsy risks; patient opinion regarding source, timing and delivery of SUDEP information; impact on health seeking behaviour. RESULTS: Ninety-eight per cent of patients were aware of medication adherence, 84% of factors influencing seizure frequency, 78% of driving regulations, 50% of SUDEP and 38% of status epilepticus; 72% of patients felt that SUDEP information should be given to all patients. Preferences for timing of SUDEP discussions varied between those wanting information at diagnosis (40%) and those preferring to receive it after three clinic appointments (18%) to avoid information overload at the first consultation. Emotional responses (48% positive, 38% negative) predominated over measurable behavioural change following SUDEP discussions. CONCLUSIONS: Less than half the patients knew about SUDEP and status epilepticus. Although the majority of patients with epilepsy wish to be informed about SUDEP early on in their diagnosis, information must be delivered in a way that promotes patient knowledge and empowerment.

10 Article Familial limb pain and migraine: 8-year follow-up of four generations. 2016

Angus-Leppan, Heather / Guiloff, Roberto J. ·1 Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, UK. · 2 University College London, UK. · 3 Faculty of Medicine and Hospital Clinico, University of Chile, Santiago, Chile. · 4 Imperial College, London, UK. ·Cephalalgia · Pubmed #26646786.

ABSTRACT: Background Migraine limb pain may be under-recognized in adults and children. There is little information about familial forms of this disorder. Objectives To describe the clinical and inheritance patterns of familial migraine limb pain over four generations and to review the evidence for limb pain as a manifestation of migraine. Methods Prospective clinical and pedigree analysis with an 8-year follow-up of 27 family members. Results Eight members of the family had benign recurrent limb pain associated with headache in a dominant inheritance pattern. Limb pain occurred before, during or after the headache, with probable or definite migraine with aura, migraine without aura and lower-half headache. The limb pain fulfilled the International Headache Society criteria for aura in six patients and also occurred without headache in three. Four members of the family had recurrent abdominal pain and/or motion sickness in childhood. Conclusions This is the first report of dominant familial limb pain temporally associated with migraine headache, starting in adulthood or starting in childhood and continuing into adulthood. A search for a genetic marker is indicated. Limb pain should be included as a childhood periodic syndrome linked to migraine and recognized as part of the migraine spectrum in adults.

11 Article A pilot study of the epilepsy risk awareness checklist (ERAC) in people with epilepsy and learning disabilities. 2010

Cole, Christine / Pointu, Alison / Wellsted, David M / Angus-Leppan, Heather. ·Barnet Primary Care Trust, Barnet Learning Disabilities Service, 313 Ballards Lane, London N12 8LY, United Kingdom. ·Seizure · Pubmed #20951336.

ABSTRACT: PURPOSE: People with epilepsy are at risk of injury, and protection from potential dangers must be balanced against the need for autonomy. We developed an epilepsy risk awareness checklist (ERAC) as a tool to assess potential risks of epilepsy and related injuries, aiming to improve management strategies. It was designed for use by specialist nurses (in learning disability and epilepsy), as there was no existing tool for this. This study refined and tested this checklist in patients with epilepsy and learning disability in a range of community settings. METHOD: We used quantitative and qualitative measures to devise and revise the tool. Eleven qualified learning disability nurses completed the ERAC in three patients each (33 patients) using a purposive sampling method. They provided quantitative and qualitative feedback through questionnaires and interviews, and an expert panel reviewed and commented on the checklist. RESULTS: The checklist was revised through the evaluation process. All eleven nurses concluded that they would use the tool again. CONCLUSION: The epilepsy risk awareness checklist (ERAC) provides a measure of risk, and this study suggests that it is a useful tool in the care of people with learning disability and epilepsy. A larger scale study is planned.

12 Minor Valproate, women, and exceptional circumstances. 2018

Angus-Leppan, Heather / Shankar, Rohit / Cock, Hannah / Anonymous7410959. ·Epilepsy Initiative Group, Royal Free London NHS Foundation Trust, London, UK. · Cornwall Partnership NHS Foundation Trust, Bodmin, UK. · Atkinson Morley Regional Epilepsy Network, St George's University Hospital NHS Foundation Trust, London, UK. ·BMJ · Pubmed #30154117.

ABSTRACT: -- No abstract --

13 Minor Network meta-analysis and the comparison of efficacy and tolerability of anti-epileptic drugs for treatment of refractory focal epilepsy. 2013

Zaccara, Gaetano / Sisodiya, Sanjay M / Giovannelli, Fabio / Walker, Matthew C / Heaney, Dominic C / Angus-Leppan, Heather / Wehner, Tim / Eriksson, Sofia H / Liu, Rebecca / Rugg-Gunn, Fergus / Shorvon, Simon D / Sander, Josemir W. ·Unit of Neurology, San Giovanni di Dio Hospital, Firenze, Italy. ·Br J Clin Pharmacol · Pubmed #23738499.

ABSTRACT: -- No abstract --

14 Minor We must warn women about the risks of untreated, or ineffectively treated, epilepsy. 2012

Angus-Leppan, Heather. · ·BMJ · Pubmed #22395928.

ABSTRACT: -- No abstract --